Provider Demographics
NPI:1881779023
Name:HAN, SUNNY DONG SUN (OD)
Entity type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:DONG SUN
Last Name:HAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DONG
Other - Middle Name:SUN
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1203 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2885
Mailing Address - Country:US
Mailing Address - Phone:626-827-4234
Mailing Address - Fax:
Practice Address - Street 1:1203 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2885
Practice Address - Country:US
Practice Address - Phone:626-827-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11056T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist